Placebo's

You may have heard this phrase "The body heals itself" or something like it. I'd argue that a placebo is proof of this statement. So why does the placebo have a bad rap? I think it is misunderstood. Let's take a look.

Anti-depressants have been under fire because a fair number of studies didn’t significantly outperform the placebo. My reaction… Wow! Look how well the placebo worked. Consider this…

1)Placebo means that thinking you are making a change can cause real change through a variety of processes in the body.

2)Placebo’s don’t have medication side effects.

Let's be clear. Placebo's don't work on everything and they rarely work alone. They represent the part of the treatment that doesn't involve the acupuncture protocol or the change in heart rhythm of a beta blocker. They are the part of the treatment that is coaxed from inside the person. Are you in worse pain when you are in a bad mood or have higher blood pressure when you are stressed? Than you know that what happens in your mind can very much change your condition in a tangible way!

Furthermore, check out this video of Ted Kaptchuck and his placebo research at Harvard. He takes it one step further and shows how engaged, quality interactions in health care, improve outcomes even more! I have patients come to me because I am with them for an hour, doing treatment AND talking through all sorts of issues.

Another somewhat troubling note. A collection of research on psychiatric medications by Robert Whitaker, shows that people's perception of a drug working is sometimes greater when they are having side effects. It goes like this, person takes a drug, feels some unpleasant side effect and figures they are getting a powerful drug. This is revealed by active placebo research, where a patient is given a placebo that also gives them some side effect like dry mouth. The reason this is troubling is that a patient can think they are getting the right drug because they are feeling some effect, which may stop them from questioning whether they are getting a therapeutic effect.

What we learn from this? A placebo can be a positive or negative thing, so we need to understand it. Also, a placebo's potency has a lot to do with the art of medicine and the interaction between caregiver and patient. As an educated public, this means that we can steer the conversation toward therapies that we feel involved in and interactions where we feel cared about. This is at the root of medicine, the idea of the placebo has been called by many names but it has always been a part of good, ethical medicine.